Provider Demographics
NPI:1437130721
Name:HENDERSON, DANA (ARNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 NEW HIGHWAY 52 E
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-5060
Mailing Address - Country:US
Mailing Address - Phone:615-644-2000
Mailing Address - Fax:615-644-2078
Practice Address - Street 1:1124 NEW HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-5060
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:615-644-2078
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3134P363L00000X
TNAPN7806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512790Medicaid
TN3348337Medicare PIN
KYP13789Medicare UPIN
KY0775703Medicare ID - Type Unspecified